Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: An Update
Adverse Effects of Medications for Low Bone Density or Osteoporosis (3 of 3)
The adverse effects associated with MHT (consisting of estrogen alone or estrogen in combination with progestin) are well known and extend to postmenopausal women taking the therapy for treatment of osteoporosis. The risk of cerebrovascular accidents is elevated by estrogen, with an odds ratio of 1.34-fold likelihood of a cerebrovascular accident (95 percent confidence interval [95% CI] of 1.07- to 1.68-fold). Combination therapy increases the risk with a 1.28-fold likelihood (95% CI from 1.05- to 1.57-fold). The strength of evidence in support of these findings is high.
The risk of thromboembolic events is elevated by estrogen, with an odds ratio of 1.36 -fold likelihood (95% CI of 1.01- to 1.86-fold). Combination therapy increases the odds again, with a 2.27-fold likelihood (95% CI from 1.72- to 3.02-fold). The strength of evidence in support of these findings is high.
Breast cancer risk was reported as an outcome of the WHI. Estrogen, as reported in Anderson et al. (2012), is associated with reduced incidence of breast cancer in women with hysterectomy when compared with placebo (hazard ratio [HR] = 0.77; 95% CI: 0.62 to 0.95), but subgroup analysis noted that the risk reduction was concentrated in women without benign breast disease or family history of breast cancer. No risk reduction was seen in women at high risk for breast cancer. In the WHI, as reported in Chlebowski et al. (2010), combination therapy is associated with more occurrences of invasive breast cancer than with placebo (HR = 1.25; 95% CI: 1.07 to 1.46), tumors more likely to have lymph node metastases (HR = 1.78; 95% CI: 1.23 to 1.58), and more breast cancer-related deaths (HR = 1.96; 95% CI: 1.00 to 4.04).
Keywords: bone | low bone density | bone density | osteoporosis | fracture | osteopenia | skeletal | teriparatide | hypercalcemia | headache | denosumab | GI | rash | infection | calcium | myocardial infarction
- Anderson GL, Chlebowski RT, Aragaki AK, et al. Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women’s Health Initiative randomised placebo-controlled trial. Lancet Oncol 2012 Mar 6 [Epub ahead of print]. PMID: 22401913.
- Chlebowski RT, Anderson GL, Gass M, et al; WHI Investigators. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA 2010;304(15):1684-92. PMID: 20959578.
- Newberry SJ, Crandall CC, Gellad WG, et al. Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: An Update to the 2007 Report. Comparative Effectiveness Review No. 53 (Prepared by the Southern California Evidence-based Practice Center under Contract No. HHSA 290-2007-10062-I). Rockville, MD: Agency for Healthcare Research and Quality; February 2012. AHRQ Publication No. 12-EHC023-EF. Available at www.effectivehealthcare.ahrq.gov/reports/lbd.cfm.
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